The proposed research, submitted by UMASS in collaboration with several IPA-model HMO's, is part of a larger interactive grant aimed at increasing breast screening among underutilizing women. The interactive collaborators include the Fred Hutchinson Cancer Research Center, State University of New York at Stony Brook, Fox Chase Cancer Center and the University of California at Los Angeles. The overall aims of the interactive application are to compare the effectiveness of Barriers- Specific Telephone Counseling in five regions of the United States and to assess the cost-effectiveness of the intervention in increasing screening among underutilizing women. UMASS will compare three interventions: One women-based (tailored telephone counseling) versus two physician-based (one an educational manual and the other a skills course) versus usual care. The interventions are based on the same theoretical models (the Transtheoretical Model and the Health Belief Model) and all three use a similar approach to staging and counseling women. Baseline telephone interviews (using core items adopted by the five grantees) will be conducted in Year 1 to assess knowledge, beliefs and practices of underutilizing women. Follow-up interviews will be conducted with the cohort in Year 4. The research focuses on the important question of how to motivate underutilizing women to participate in regular breast screening. There should be wide generalizeability since the research is being conducted in five settings across the country with a range of comparisons across delivery settings and populations. Each grantee will include a substantial proportion of older, poorer, minority, and less well educated women.